ࡱ> "$ !C }bjbj *hht @@8lHlM@pL???????$BsE?""?@@@f&f&f&@8?f&?f&f&0:x;aZt;?@0M@2;SF^SF,;SF;f&??#XM@SF X :  Patient Information Leaflet: Having a gallbladder operation  This information leaflet has been created and approved by the Portsmouth specialist laparoscopic gallbladder surgeons: Miss A. M. Walters M.D. F.R.C.S Prof S.K.C. Toh M.B.B.S F.R.C.S.(Gen Surg) Mr S.S. Somers B.Sc. (Hons). M.D. F.R.C.S. Mr S.J. Mercer M.A. D.M. F.R.C.S. Mr N.C. Carter M.Sc. F.R.C.S. Mr. B.C. Knight M.B.Ch.B. F.R.C.S. Mr G. van Boxel PhD F.R.C.S Mr P.H. Pucher PhD F.R.C.S Mr. K.Graetz D.M F.R.C.S. Mr R.Sutaria B.Sc. (Hons). M.D. F.R.C.S. Mr S. Horvath M.D. Please retain this leaflet to refer to AFTER your operation Further information is available at:  HYPERLINK "http://www.nhs.uk/Conditions/Gallstones/Pages/Introduction.aspx" www.nhs.uk/Conditions/Gallstones/Pages/Introduction.aspx  HYPERLINK "https://www.rcseng.ac.uk/patient-care/having-surgery/" https://www.rcseng.ac.uk/patient-care/having-surgery/ Having a Gallbladder Operation  What is a gallbladder? The gallbladder is a muscular storage bag, roughly the size of a small pear. The gallbladder is attached to the liver (this is on the upper right side of your tummy, just behind your lower ribs). What does the gallbladder do? It acts as a storage tank for bile. Bile is continuously produced by the liver, from where it travels down a tube (called the bile duct) into the duodenum (the part of the intestine that food enters once it leaves the stomach). Bile mixes with food and is necessary for normal digestion. If you have not recently eaten, bile is diverted from the bile duct into the gallbladder. When you next eat, the muscle of the gallbladder wall squeezes the bile back into the duodenum to help digest food. This is why the pain of gallstones tends to occur after a meal. What problems can gallstones cause? Gallstones are very common. They are found in 10-15% of people. Most people with gallstones do not get any problems from their gallstones. If gallstones are not causing problems we leave them alone. If gallstones are causing problems we usually offer an operation to remove the gallstones and gallbladder. Gallstones can cause a number of issues: Pain. Usually in the upper part of the tummy, more to the right side. This can last for a few minutes up to a few hours. This is often caused by eating something fatty or greasy. This is called biliary colic. Infection and inflammation of the gallbladder. This causes pain in the upper part of the tummy, more to the right side. This can make you feel unwell and feverish. This is called cholecystitis. Jaundice. Your skin and the whites of your eyes turn yellow. Your urine may go dark and your bowel motions can turn pale. This occurs when a stone escapes from the gallbladder and gets stuck in the bile duct. Acute pancreatitis. Gallstones can cause inflammation of your pancreas gland. This causes a severe indigestion-type pain in your tummy. This often requires admission to hospital. This can cause serious, life-threatening problems. Can I live normally after having my gallbladder removed? Yes. Most people notice no difference after a gallbladder operation. There are no dietary restrictions once your gallbladder has been removed. Occasionally a patient reports that their bowels work more frequently, but this is unusual. Some patients who have Irritable Bowel Syndrome (IBS) notice that this becomes worse after their gallbladder has been taken out; the cause of this is unclear. Why did I get gallstones? We dont really know the cause of gallstones. They are more common in women and seem to run in families. They are more common in older people and in certain other medical conditions such as Crohns Disease. Gallstones are formed when thick bile in the gallbladder settles out as stones. Gallstone can come in many different sizes and shapes, ranging from tiny grains of sand to a single stone the size of an egg! The number and size of gallstones bears no relationship to the amount of discomfort they may cause. Can gallstones be removed without surgery? No. At one time there was an attempt to dissolve gallstones with medication. These tablets caused uncomfortable side effects which patients found even worse than the symptoms caused by gallstones! The gallstones also came back within a few months of stopping the tablets. Doctors have tried to shatter gallstones with ultrasound waves. The fragments of gallstones either joined back together again or passed out of the gallbladder into the bile duct. This caused pain and sometimes resulted in jaundice (yellowing of the skin and eyes) or inflammation of the pancreas gland (acute pancreatitis) which can be a serious, life-threatening disease. Why do I have to have my gallbladder removed, not just the stones? If only the stones are removed, your gallbladder will make more gallstones and you will have the same trouble all over again. Most patients with gallstones have a gallbladder that has lost its ability to function because of scarring due to the gallstones. How is the gallbladder removed? This is usually done with keyhole surgery (called a laparoscopic cholecystectomy). You will have a general anaesthetic (put to sleep). The surgeon will make 3 or 4 small cuts (1.5cm/0.5inch or less) on the front of the tummy. Your tummy is then blown-up with gas so the gallbladder can be seen clearly. A camera and long thin instruments are put into the tummy through these cuts. The gallbladder is then separated from the liver. Will any other procedures be performed during my operation? Possibly. These include: Open operation. If the gallbladder is very inflamed or there is a problem during the operation, it may not be possible to perform the operation with keyhole surgery. In this case we perform an open operation. This involves making a 10-20cm cut on your tummy. If you have an open operation your recovery will be longer than keyhole surgery. You may have more pain and sickness. You will need to spend several days in hospital. Your recovery at home will be longer. It is very unusual that we cant remove your gallbladder with keyhole surgery (1 in 200 chance). Drain. If we are worried about collections of fluid forming inside your tummy after the operation, we sometimes leave a drain. This is a thin plastic tube that sticks out of one of your wounds. This is connected to a bag which collects the fluid. If a drain is used, it usually stays for one or two days after your operation. The drain is often removed on the ward with little discomfort. It is unusual for us to leave a drain. X-ray. We sometimes perform an X-ray during the operation to see if there are gallstones in the bile duct. This is called a cholangiogram. This involves injecting a dye into the bile duct and then taking an -x-ray. The dye is made of iodine. You need to let us know if you are allergic to iodine or shellfish, as that may mean you cannot have that x-ray. What do you do if you find stones in the bile duct? Stones stuck in the bile duct can be managed in several ways. If the stones in the bile duct are small, we sometimes leave them alone as they can pass on their own. We may ask to you to have a blood test or scan after your operation to check if they have passed. If there are bigger gallstones stuck in your bile duct, we can sometimes remove them at the time of your gallbladder operation. This is called a bile duct exploration. This involves making a small cut on the bile duct and then removing the stones with a small camera. We then close the cut with stiches. If we cannot remove stones stuck in the bile duct during your gallbladder operation, we can arrange for them to be removed on a separate date after your operation. This is done by a procedure called an ERCP. This procedure is similar to a gastroscopy (camera test into the stomach). This is performed in the hospital under general anaesthetic or sedation. Is the bile duct exploration procedure safe? Yes. The main risk of bile duct exploration is bile leaking from the cut we make in the bile duct. We usually leave a drain after this procedure in case a leak occurs. The risk of a leak happening is small (less than 10%). If a leak does happen bile will drain from inside your tummy, through the drain tube into the drain bag. Most leaks will stop on their own after several days. We often send people home with their drain and ask them to come back after several days to have the drain removed. Occasionally a leak will not stop on its own. If this happens you may need to have an ERCP procedure or operation to help it stop. This is unusual. Will I have to be shaved for surgery? If your tummy is quite hairy your surgeon may shave part of it. This allows dressings to be put on your wounds after the operation. If you have a lot of hair on your thigh, a small area of hair may be shaved off. This is to allow the use of electrical cautery during your operation; this seals off little blood vessels. Any shaving is done once you are asleep in the operating theatre. Can I have my operation as a day case? Yes. Most people who have keyhole gallbladder surgery will go home the same day as their operation. You must be fit and healthy. You must have a responsible adult to stay with you for 24hrs. If you have small children you will need to have a responsible adult to look after them. This may necessitate a partner taking a couple of days off work to look after you. Can there be complications of an operation to remove my gallbladder? Yes. All operations carry a risk. There are general risks that are common to all operations: Wound infection. The skin around the wounds may go red and painful, or the wounds may leak smelly fluid. Around 2 in 100 patients will experience this. This usually happens once you are at home. Bruising. It is quite normal to experience some bruising where your wounds are. Often this does not appear until you have gone home from hospital. Occasionally a very large bruise may form which takes one or two weeks to go away. The wounds may ooze a little bit of blood for the first 48hrs, requiring a change of wound dressing. This is quite normal. Chest infection. If you develop a cough, or feel short of breath after your operation, you may have developed a chest infection. This is rare if you are fit and healthy (less than 1 in 100 cases). You are at higher risk if you are overweight, if you are a smoker or if you have a lung disease (chronic bronchitis, emphysema, COPD, severe asthma). Internal bleeding. This is rare (occurring in less than 1 in 100 operations). This occurs within the first 24hrs following surgery. It is usually detected before you leave the hospital. It may require you to have a blood transfusion, or a second operation in order to stop the bleeding. Allergic reaction to antibiotics or anaesthetics. This is rare (occurring in less than 1 in 100 operations). If you have had a previous bad reaction to a medication or to an anaesthetic you MUST inform the surgeon or the anaesthetist before your operation. You must tell us if you have a shellfish allergy or a latex allergy. Blood clots in the legs and lungs. A blood clot in the legs is also known as a deep venous thrombosis (DVT). A blood clot may cause pain or swelling in the leg (usually in the calf muscle). A fit healthy person has a very small risk of blood clots. Your risk is higher if you are overweight, a smoker, in poor general health, have difficulty walking, or have had a previous blood clot. To reduce your chance of developing a blood clot you will be encouraged to get out of bed as soon as you can. While you are on bed rest, you should exercise your calf muscles by moving your feet up and down. If you are at high risk of having a blood clot you may be given an injection (called heparin) after your operation. Pulmonary embolism. This is when a blood clot from the legs travels to the lungs. The clot can block the blood supply to part of the lung. This can be a life-threatening condition. This can give you chest pain or make you feel short of breath. If you become breathless after your operation you should attend the Emergency Department. There are risks specific to the gallbladder operation: Bile leak. A collection of bile fluid can form inside your tummy after the operation. This is rare (occurs in about 1 in 100 gallbladder operations). This is usually diagnosed in the first few days after the operation. Signs of a bile leak include: persistent nausea, an inability to eat or drink and severe tummy pain. You may also feel faint, and have a fast heart rate, or you may develop jaundice (yellowing of the skin and whites of your eyes, with dark coloured urine). If your surgeon suspects a bile leak they will usually carry out a further keyhole operation to inspect the inside of your tummy. If bile is present, it will be washed out and a plastic tube (called a drain) will be brought out through the skin, to allow any further bile to drain out. If the bile leak does not stop by itself, you will need a special endoscopy test called an ERCP to identify the source of the bile leak, and to stop it. Gallstones in the bile duct. It is possible that small gallstones may slip out of the gallbladder into the bile duct during your operation. If this happens you may become jaundiced or experience pain similar to that which you had before your operation. This occurs in around 1 in 100 gallbladder operations. This can occur days, weeks or even months after your operation. This is usually dealt with by an ERCP procedure as described above. Gallstones left behind in the tummy. Occasionally gallstones can spill into your tummy during the operation. Your surgeon will attempt to gather up all these stones but sometimes they hide out of sight and cannot be collected. Very rarely (less than 1 in 1000 chance) these lost stones can cause an infection inside your tummy months or years later. If this happens, a further operation to collect the infected stones and treat the infection is required. Damage to main bile duct. This is a serious but rare complication. This occurs in around 1 in 500 gallbladder operations. If damage is recognised at the time of the operation, we may try to repair it. This often requires open surgery i.e. a large cut and not keyhole surgery. Damage to the bile duct may show up within the first few days, weeks or months after your operation. You may become jaundiced or experience tummy pain. You will need blood tests, and scans to diagnose the problem. Major surgery is usually required to deal with all but the slightest damage. Damage to bowel. This is rare. Bowel damage is usually seen at the time of operation and can be fixed with keyhole surgery. Sometimes this requires an open operation. Rarely, bowel damage is not seen at the time of the operation, and a second operation within days of the original operation is required to deal with it. If you do suffer this rare complication, it will prolong your stay in hospital. There are risks specific to the patients general health: If you have heart disease: gallbladder removal is major surgery, which can put a strain on existing heart problems, resulting in a heart attack around the time of surgery. This may result in death, or prolonged ill health. You may have to have a heart scan (echocardiogram), and an anaesthetic review in advance of surgery. You may also require review by a heart specialist (cardiologist). If you have breathing problems: you may require special tests on your lungs, and an anaesthetic review. Your risk of developing a chest infection (pneumonia) will be markedly increased. People with severe breathing problems may require admission to Intensive Care for observation, sometimes for support on a breathing machine. If you are on blood thinners (warfarin/dabigatran/rivaroxaban/apixaban/ edoxaban): these will have to be stopped a few days before your operation. We will tell you when to stop your blood thinning medication before your operation. For most patients it is safe to stop blood thinning medications for a few days. Some patients cannot stop taking their medication (such as patients with artificial heart valves). In this case will swap your tablets for heparin injections a few days before your operation. We will tell you when it is safe to re-start your medications after your operation. If you are on aspirin: this increases the chances of bruising and bleeding around the time of surgery. Most surgeons will ask you to stop your aspirin 3 days before your operation. Most surgeons will ask you to start taking it again the day after your operation. Some surgeons will not ask you to stop aspirin before surgery. We will give you advice on this before your operation. If you are on clopidrogel/prasugrel: these drugs are similar to aspirin, but are more powerful. Failure to stop this medication puts you at risk of major bleeding and bruising. You will need to stop this medication 7 days before your operation. You can restart it a day two after your operation. If you have diabetes: well controlled diabetes is often not a problem if you are having gallbladder surgery. You are still likely to be able to have your operation as a day case if you are otherwise well. If you have had poorly controlled diabetes for many years, it may have had a bad effect on your heart and kidney function, and problems with your circulation: if this is the case then the risks to your life of having gallbladder surgery is increased. If you are overweight: this increases your chances of developing a blood clot in the legs and the lungs. You are also at increased risk of developing a chest infection (pneumonia). People who are overweight are also at risk of diabetes and heart disease, which also increases your risks when having surgery (as described above). If you are a smoker: you are at increased risk of developing a chest infection and blood clots in the legs after an operation. You are at increased risk of a wound infection. You are at increased risk of developing a heart attack around the time of surgery. If we feel you are a high-risk patient, we will tell you. Is it possible to be too unfit for gallbladder surgery? Yes. Some people are in too poor health to have major surgery. We may ask an anaesthetic doctor to help us assess whether a person is fit for surgery or not. If you are advised by a consultant surgeon not to have surgery on your gallbladder, but you still wish to have the operation, you should ask for a second opinion from another consultant surgeon. We will arrange this for you, or we will ask your General Practitioner to arrange it for you. Can people die having gallbladder surgery? Yes, but this is very uncommon. Surgeons and anaesthetists are careful not to operate on people where the risks of surgery outweigh the benefits. Overall, around one person out of a thousand having gallbladder surgery will die. This is usually due to a post-operative complication such as a heart attack. Your risk is clearly more if you are elderly or in poor health, than if you are young and fit. Is there anything I can do to improve my health before having surgery? If you are a smoker, you should stop as far in advance of your surgery as possible (at least 6 weeks). Your General Practitioner or practice nurse will be able to give you some advice. More information can be found at  HYPERLINK "http://www.nhs.uk/better-health/quit-smoking/" www.nhs.uk/better-health/quit-smoking/ If you are overweight, you should try and lose weight, to get down to your target weight for your height. Your General Practitioner may have a nurse in the practice that can help you with a weight reducing diet. More information can be found at  HYPERLINK "http://www.nhs.uk/better-health/lose-weight/" www.nhs.uk/better-health/lose-weight/ If you are seriously overweight, we will ask you to go on a milk diet. This shrinks your liver down to a normal size to allow the surgeon to access your gallbladder. If you need to go on a milk diet we will provide you with a separate information leaflet. If you are diabetic, you need to keep your blood sugar levels in the correct range. If you have high blood pressure, this needs to be well controlled before you can have surgery. While I am waiting to have my gallbladder removed, is there anything I can do to prevent attacks of pain from my gallstones? Yes. You need to keep to a very low-fat diet. This means avoiding butter, full fat milk, cream, cheese, chocolate etc. You should avoid any oily foods, and grill, rather than fry, your food. Keeping strictly to this sort of diet usually means you will lose weight. Your General Practitioner may already have given you a supply of strong painkillers to have in reserve should you have another attack of pain. If not, you can ask them for some painkillers. If I have my gallbladder and gallstones taken out, will all my symptoms go away? If your symptoms were due to gallstones, then you will be relieved of your symptoms once you have recovered from your operation. Gallstones are very common, and you can have them at the same time as a variety of other conditions that can cause similar symptoms. There is always a small chance that removing your gallbladder will not solve the problem. If we feel that your symptoms are possibly not due to gallstones, we will warn you of this before we take your gallbladder out. We may ask you to have other investigations on the stomach or bowel. I had an investigation for something else, and I was told I had gallstones, should I have my gallbladder out? As a general rule, we dont recommend surgery to prevent trouble from gallstones. Many people have gallstones and live their entire lives without having symptoms from them. AFTER YOUR GALLBLADDER OPERATION How soon can I go home after my operation? To be able to go home you must be able to drink, eat light meals, and be able to walk about comfortably. You must also be able to pass urine normally. Most day case patients are able to go home around 4 hours after they have come round from the anaesthetic. On occasion your surgeon may encounter an issue during your operation that will require you to be kept in hospital. This occurs in around 1in 50 operations. If you have nobody to stay with you on your first post-operative night, if you are in poor health, or are otherwise frail your operation may stay in hospital overnight, or longer. Will I have pain after my operation? Most people need to take painkillers after their operation. These will be supplied by the hospital for you to take at home. You should take the painkillers as directed on the packet to make you feel comfortable enough to be able to move around the house. Everyone is different when it comes to experiencing pain after an operation, so we can only give you an estimate about how you will feel. If you feel that you still need painkillers after the hospital supply has finished, you will need to contact your General Practitioner. Will I need to have somebody to look after me at home? Yes. After day case surgery you should have a responsible adult able to stay with you for 24hrs. Many people feel tired and woozy after a general anaesthetic, so someone able to look after you by making hot drinks, light meals etc is helpful. They can also telephone the hospital on your behalf if you have an unexpected problem. After the first 24hrs, it is helpful to have someone able to do shopping or run errands for you, until you are fully mobile Will I need a special diet after my gallbladder is removed? No. For the first few days after your operation you may not have much appetite. We advise you to eat smaller meals than usual until you feel your appetite has fully recovered. What will I be able to do when I go home? It is normal to feel a bit of tummy bloating, tiredness, and be a bit sore for several days. With keyhole surgery, the pain can often be felt in the shoulder. Your tummy may remain a little swollen for one to two weeks afterwards. This is quite normal after this surgery. You should rest and eat only light meals for the first day or two. You should avoid any alcohol while taking painkillers stronger than paracetamol. You may be constipated, this is as a result of missing normal meals around the time of your surgery and can be a side effect of some painkillers. This should settle by itself. If not, you can use a gentle laxative that you can buy from any chemist. You will probably not feel like leaving the house for the first couple of days, but make sure you walk about within the house or around the garden every couple of hours during waking hours. This will keep the blood circulating in your legs and reduce the chance of a blood clot forming in the legs (known as deep venous thrombosis). You will tend to make a faster recovery if your operation was done as a planned operation. If you were admitted to hospital as an emergency, it will often take a bit longer to recover from your operation because you were ill when you were admitted. What should I do with my wounds? Your wounds will be covered by a dressing. For the first couple of days, it is not unusual to have slight blood leakage on to the dressing. The dressings are waterproof and you may shower with the dressings on. If your wound is clean and dry after 4 days you may have a shower with the dressings off (7 days for a bath). Extra dressings can be purchased at most chemists if you feel you need them. Will I need to any have stiches removed? Most surgeons use skin stitches that dissolve by themselves. We will tell you if this is not the case. How will I know if my wounds are healing properly? Most wounds heal without problems. You do not need to visit your GP or practice nurse unless you think there is a problem, or if you are concerned. It is normal for a wound to feel hard and tender for several weeks. It is quite normal for you to feel a lump under the wound, as this is the healing ridge of tissue. The scar will look red, and often remains red for many months. When will I be able to go back to work? This depends on your type of work, and whether you had keyhole surgery or open surgery. A desk job can be returned to after a week or two if you have had keyhole surgery, or around four weeks with open surgery. A heavy manual job will require longer off work, around three to four weeks off for keyhole surgery, and six to eight weeks for open surgery. Please ask us for a fit note (Statement of Fitness for Work) on the day of your operation. When can I start to drive again? Once you can comfortably use all the controls in the car and when you are no longer taking strong painkillers. You must be able to perform an emergency stop and be able to turn round in your seat to safely reverse the car. We usually recommend not driving for three or four days after keyhole surgery, and around ten days for open surgery. It is always best to check with your insurance company to see if they have any specific rules related to the type of operation you have had done. This is particularly important for professional drivers e.g. taxi drivers, HGV drivers Will I be given a hospital review appointment after my operation? Most people will make a straightforward recovery We do not routinely see patients after a gallbladder operation. If you have problems your General Practitioner cannot solve they will refer you back to see your surgeon. Symptoms requiring you to seek medical attention: Nausea/vomiting Anaesthetics and painkillers can make you feel sick. Missing food for two or three days after your operation is not a problem (unless you are diabetic) but you must be able to drink at least a litre of fluid a day without being sick. If you cannot do this you must return to the hospital. If you are diabetic and cannot eat you must return to the hospital Inability to pass urine If you cannot pass urine or feel you have to keep passing urine, but are passing only small amounts each time this usually means that your bladder has overfilled and cannot empty. You will need to return to the hospital and may need a tube put into the bladder to empty it out. A lot of pain If your pain is stopping you from moving about (e.g. getting to the toilet) despite taking the painkillers as directed by the hospital, you should contact the hospital if it is within 72hrs of your operation, otherwise contact your general practitioner. You notice your skin becoming yellow This means you have jaundice. The whites of your eyes will usually also look yellow, and your urine will go very dark. If this happens within the first two weeks after your operation you should contact the hospital. After two weeks you should visit your GP. Wound infection If your wound develops redness spreading out from the scar, or weeps fluid requiring more than one dressing change a day, or is still weeping after four days you should see your practice nurse. Swollen leg Swelling of the leg below the knee, particularly if it is only on one leg, may indicate that you have developed a blood clot in the leg (deep venous thrombosis). This usually takes a few days or weeks to show up after your operation. You need to see your GP or return to the hospital immediately if you notice this. Shortness of breath If you have become short of breath when you normally would not be, within the first 3 months after your operation, you should see your general practitioner or return to the hospital to be checked out for a blood clot to the lung (pulmonary embolus) or a chest infection.  5th January 2005 Revised 28th October 2009 Revised 17th February 2016 Revised November 2021     PAGE   Who can I contact if I feel something isnt right after my gallbladder operation? If you feel unwell or you think there is a problem in the first week after your operation, please contact us. 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